NEW DELHI - India has supplied more doses of the Covid-19 vaccine elsewhere than it has administered to its own people, a top Indian diplomat told the United Nations General Assembly last week.
Notwithstanding global praise for its altruism, the government in New Delhi is reassessing its international supplies with the worrying spike of new infections at home.
As at Tuesday (March 30), India has exported 64 million doses to around 84 countries, while a million fewer doses had been administered within India.
But outbound vaccine supplies have been tightened as the number of daily cases has shot up from under 20,000 to over 50,000, with the Ministry of Health and Family Welfare warning that the situation had gone from "bad to worse".
Domestic demand for vaccines is anticipated to go up from Thursday (April 1) as the world's second most populated country starts vaccinating all citizens aged 45 and above, with the target of inoculating 300 million people by August. So far, only health and front-line workers, senior citizens aged above 60 and those above 45 with chronic illnesses were eligible.
Despite the reassessment, India will continue supplying to other countries "in a phased manner", sources said.
"We have not imposed any ban on exports of vaccines unlike many other countries," the sources said.
Foreign Minister S. Jaishankar, keen to dispel any notion that India's vaccine diplomacy has stalled, over the past few days tweeted pictures of shipments of India-made vaccines arriving in various countries, including Palestine, Paraguay, Niger, Zimbabwe and Fiji.
"Reaching Ramallah. Made in India vaccines arrive in Palestine," he tweeted on Tuesday.
India rolled out an ambitious vaccine export programme, rivalling China's, in a move to fortify its international influence.
The programme was underpinned by India's manufacturing prowess in the pharmaceutical sector. The South Asian country is the world's third-largest producer of drugs and supplies nearly 60 per cent of global demand for vaccines.
India has approved two vaccines for public use. One is called Covishield, which is the name for the Oxford-AstraZeneca vaccine that is being manufactured by the Serum Institute of India (SII). The other is the indigenously developed Covaxin from Bharat Biotech.
Mr Oommen C. Kurian, the head of the health initiative at the Observer Research Foundation, a think-tank, said the Narendra Modi-led government had taken a "big domestic political risk" by exporting vaccines.
"If India still continues to export large numbers of doses without expanding immunisation considerably now that cases, as well as deaths, are rising, the Bharatiya Janata Party's core constituency may not like it. The government is, therefore, likely being cautious," he told The Straits Times.
"Two weeks down the line, we don't know how many vaccines we will need. We may even choose to go for universal vaccination in some districts or even states," he added.
The squeeze by India has hit Covishield supplies to 64 low income countries through the Covax Facility, an international vaccine-sharing initiative. Covax said last week that some deliveries anticipated in March were now expected in April due to an increased demand within India. Covax has received 28 million Covishield doses and was expecting an additional 40 million to be available in March, and up to 50 million in April.
SII is expected to supply 240 million vaccine doses for Covax and around 97 million of these are earmarked for India as part of Covax's interim global distribution forecast. "India has drawn only 10 million doses from this Covax quota so far, which is well within its planned allocation," Mr Kurian said.
"The biggest beneficiary of the Covax SII vaccine - India - was doing all right, so to speak, when initial Covax allocations were planned. Now we are in trouble, so allocations are understandably being recalibrated," he added.
SII did not respond to a set of questions from The Straits Times, saying it would not comment on any matter related to vaccine exports. In February, its chief executive, Mr Adar Poonawalla, tweeted that countries ought to be "patient" as the firm had been "directed to prioritise the huge needs of India and along with that balance the needs of the rest of the world".
He has also flagged imported raw material shortages that have affected production, attributing the scarcity to US export bans on specific items needed to make vaccines. The firm had planned to boost production to 100 million doses a month from March but current monthly production levels are reported to be around 70 million.
The firm delayed Covishield shipments to Brazil, Britain, Morocco and Saudi Arabia recently.
At least two Indian states - Rajasthan and Odisha - have complained about vaccine shortages, which have forced them to scale down their vaccination efforts. The federal government, however, maintains that supplies are adequate and that exports have not come at the cost of the national interest.
India is expected to soon approve a third vaccine - the Russian-made Sputnik V - in an effort to ramp up availability. It will be distributed domestically by Dr Reddy's Laboratories, a firm headquartered in Hyderabad.
But Ms Nissy Solomon, a senior associate for research at the Centre for Public Policy Research, said India's vaccine approval system had subjected foreign vaccine makers to "umpteen regulatory compliances". This, she said, restricted the production of vaccines that had been approved elsewhere and undergone necessary clinical trials.
In February, Pfizer withdrew its application to allow its vaccine to be made available in India. India's Drug Controller-General of India declined approval, citing reports of "palsy, anaphylaxis and other severe adverse events" after the vaccine's approvals in some other countries.
"While trials can be undertaken to understand the efficacy of vaccines among the locals in India, the moot question remains as to why there is a need to restrict the production of these vaccines (in India), which have been approved by many countries and, therefore, can be exported to them," added Ms Solomon.